MEMORANDUM

TO: NYS Medicaid Managed Care Plans (MMCPs)
 

FROM:

 

New York State Office of Mental Health (OMH)

           
DATE:  March 31, 2020
 

SUBJECT:     Telephonic Billing For Continuing Day Treatment & Partial Hospitalization

The purpose of this memo is to update MMCPs on telephonic billing for Continuing Day Treatment (CDT) and Partial Hospitalization (PH) programs.  This guidance expands upon the March 11 2020[1] Use of Telemental Health for People Affected by the Disaster Emergency guidance.[2]  OMH-issued emergency telemental health guidance remains in effect and can be found on the OMH guidance webpage. This guidance is effective for the duration of the declared disaster emergency and covers service requirements for Medicaid reimbursement as well as billing methodology for telemental health.

Providers of PH are able to use telemental health as outlined in the supplemental guidance. To bill for PH telemental health, when the normally required time of at least four hours with the individual is not met, providers may bill the crisis rate codes in hourly units (4357-4359)[3] up to three hours. This applies as long as at least one hour has been spent providing a PH service. If a provider spent four or more hours, the regular PH rate code should be used.

Providers of CDT are able to use telemental health as outlined in the supplemental guidance. In order to bill for CDT telemental health when the normally required minimum time frames with the individual are not met, providers may bill the crisis rate code (4337) which has no time limitation.

Any questions regarding this memo may be directed to the OMH Division of Managed Care: bho@omh.ny.gov.

[1] This was transmitted to MMCOs on March 16, 2020

[2] The most up to date version of this guidance can be found here https://omh.ny.gov/omhweb/guidance/

[3] The rate code/procedure code combination is listed in the coding taxonomy document available here https://omh.ny.gov/omhweb/bho/docs/coding-taxonomy.xlsx

 

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